Wendy Keller wishes she were back in the good old days – when health insurance actually covered the cost of a doctor’s appointment and even hospital stays only resulted in a single bill.

“Now, you get a bill from every doctor who walks in the door. It’s insane,” the Annville resident said.

Keller gets her health insurance through the Affordable Care Act-created marketplace – but it’s anything but affordable. Between her deductible and her monthly premiums, she is paying about $10,000 each year before her plan will cover expenses.

“It’s ridiculous,” she said, and it takes a huge chunk out of her overall budget. “You can’t do things. You can’t enjoy much anymore, because the money comes (out for health care), and that’s it.”

The good old days of health insurance aren’t coming back, regardless of whether Republicans in Congress successfully pass a recently proposed “Obamacare” replacement.

However, whether or not the GOP proposal makes matters better or worse depends where you stand, experts said.

Here’s a look at how Lebanon County residents with various types of insurance would be impacted by the proposed law.

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House Republicans have unveiled their replacement plan for the Affordable Care Act. The plan differs from Obamacare in various ways.
Time

Marketplace insurance - young or “rich”

Amount of Lebanon County residents: 3,838 Lebanon County residents are on Marketplace Insurance, as of February 2016, the most recently available federal data.

Overall verdict: You’ll likely fare better under the GOP plan

People like Keller were left behind by “Obamacare,” said certified application counselor Jan Wessell, who helped many Lebanon County residents find insurance.

Wendy Keller hasn't been satisfied with her Marketplace insurance, between the complicated website and tax reporting issues, high premiums and high deductibles.(Photo: Jeremy Long, Lebanon Daily News)

Keller works for a small business that is exempt from the employer mandate to provide insurance. She makes enough money to prevent a large government subsidy for her health care.

While the plight of the middle class often doesn’t inspire sympathy, Wessell said the current health care market can put them in a financial pickle. Many people who sought her assistance were 55-plus and had good incomes and no longer had the expense of raising kids, but needed to save money for retirement.

The premium options available to them are simply “unworkable,” she said.

If you are 40 or younger and make at least $40,000 – or at least 60 years old but make at least $75,000 – you’d receive more government support in paying your health insurance under the new plan, the analysis found.

Marketplace insurance – old or poor

Amount of Lebanon County residents: 3,838 are on Marketplace insurance, as of February 2016, the most recently available federal county-specific data.

Overall verdict: The GOP plan would likely take a bite out of your wallet

While the Marketplace didn’t work for everybody, the “Obamacare” subsidies did benefit the poor, particularly young families and single parents with children, Wessell said.

“I frequently had people say, ‘if I didn’t get those subsidies, I couldn’t afford it,’” she said.

Health care subsides will typically be better for the young and richer and worse for the old and poorer under the GOP health care plan. Based on Lebanon-county specific data from the Kaiser Family Foundation.(Photo: By Daniel Walmer)

If you’re in that category, your government support would be scaled back under the Republican plan. Lebanon County residents who make $30,000 per year or less – and those over 60-years-old who make $50,000 or less – would get fewer dollars from tax credits under the GOP bill than they currently do from subsidies, according to the Kaiser Family Foundation.

To Lebanon-area doctor Bill Davidson, that’s part of why the Republican bill is a “pretty blatant” attempt to transfer wealth to the upper classes.

“It favors people who are well off, and that’s the bottom line with it,” Davidson said. “If you’re young and well off, this legislation works to your advantage.”

Of course, not everyone of lesser means is loving the Marketplace, either. Many patients seeking free medical care at Lebanon Valley Volunteers in Medicine had abandoned the Marketplace because they found the costs of premiums too high and the coverage insufficient, said executive director Linda Jackson.

Medicaid enrollees

Amount of Lebanon County residents: 27,851, according to the Pennsylvania Health Access Network. About 6,480 have gained access through Medicaid expansion.

Overall verdict: Your health insurance could be in jeopardy.

Most Lebanon County residents who are directly impacted by the Republican-proposed American Health Care Act are on Medicaid.

Although most media attention has focused on the proposed phasing out of Medicaid expansion, even people who have been on Medicaid for years would be impacted.

“There were a lot of people in Lebanon County, they were looking at Medicaid or nothing.”

Jan Wessell, certified application counselor

First, the expansion. The AFA allowed states to expand Medicaid to people making up to 138 percent of the federal poverty level, something Pennsylvania did after the 2014 election of Democratic Governor Tom Wolf.

Jackson and Wessell said that’s been far more effective than the Marketplace in helping the previously uninsured become covered.

“There were a lot of people in Lebanon County, they were looking at Medicaid or nothing,” Wessell said.

Under the GOP bill, states could not enroll new people under the expansion after 2019. U.S. Rep. Ryan Costello - a Republican who voted in favor of moving the ACHA out of committee - said in a written statement that he opposes any effort to accelerate that process.

Now to the bigger picture. The newly proposed bill would also cap federal Medicaid reimbursement to states at 2016 per-enrollee costs plus an inflation metric.

Nearly half of Medicaid recipients in Pennsylvania are children benefiting from programs such as the Children’s Health Insurance Program (CHIP), said Antoinette Kraus, director of the Pennsylvania Health Access Network.

“The state is going to be forced to cut benefits, and you’re talking about cutting benefits from kids,” said Kraus. “It’s completely destroying the safety net that hard-working Pennsylvanians rely on to access care.”

The uninsured

Amount of Lebanon County residents: About 6 percent, according to the Pennsylvania Health Access Network.

Overall verdict: There will be more of you – at least if you trust the CBO.

House Speaker Paul Ryan had a different explanation for why the CPO said less people may be covered: they’d no longer be required to buy insurance.

Wendy Keller hasn't been satisfied with her Marketplace insurance, between the complicated website and tax reporting issues, high premiums and high deductibles.(Photo: Jeremy Long, Lebanon Daily News)

“We’re saying the government is not going to force people to buy something they don’t want to buy,” Ryan told Bret Baier of Fox News. “Of course, they’re going to suggest that if we’re not going to make people do something they don’t want to do, they’re not going to do it.”

When people don’t have insurance, they typically wait until a crisis to seek help in an emergency room, where hospitals are legally bound to treat them regardless of ability to pay, said Paula Bussard, chief strategy officer for the Hospital and Healthsystem Association of Pennsylvania. Hospitals either struggle financially or pass on those costs to other consumers, she said.

The Affordable Care Act helped increase the amount of people ensured and undergoing preventative health care measures, which drove down the amount of patients in emergency rooms without insurance, Bussard said.

“It benefits everybody when everybody is insured,” agreed Holly Dolan, director of education and outreach at Lebanon Family Health Services. “We’re all in this together.”

Penn State Hershey Medical Center has seen a slight decrease in the percentage of emergency department visits from the uninsured, accompanied by an increase in those with Medicaid, according to a hospital spokesman.

Penn State Health CEO A. Craig Hillemeier said that while they are still reviewing the newly proposed ACHA, “we believe the goal of any comprehensive health care legislation should be to support access to care and coverage for as many people as possible.”

Insurance through employer

Amount on insurance provided through an employer: 55 percent of all Pennsylvania residents, as of 2015, according to the Kaiser Family Foundation.

Overall verdict: Unclear, but your benefits could be impacted

Visions of the ideal health care system in America go far beyond the changes to subsidies and Medicaid currently proposed by House Republicans.

Davidson supports a single-payer system in which the government directly pays health care costs, which the Labor Campaign for Single Payer Healthcare says on its website is “the only solution that will control costs, increase access and improve the quality of care.” On the other side of the political spectrum, libertarian Sen. Rand Paul (R-KY) introduced a bill designed to decrease insurance costs by deregulating the market, allowing insurers to cross state lines and allowing individuals to form their own large pools to negotiate with insurance companies.

Still, the narrower GOP alterations to “Obamacare” could impact cost and quality of coverage for people who get insurance through their employer.

“The (Republican strategy) is allowing for these catastrophic plans to come back into place. It’s kind of a big step backwards for public health.”

Holly Dolan, Lebanon Family Health Services

The bill keeps the requirement that insurance companies cover everyone regardless of pre-existing conditions but repeals the individual mandate. However, it allows insurance companies to charge an extra 30 percent penalty if someone wants a plan after a break in insurance coverage. It also repeals several taxes on medical and pharmaceutical companies. Several experts said it’s tricky to determine at this point what impact all of those changes will have on workplace rates.

The more direct impact of changes to the ACA could be on quality of coverage. Dolan said that while the specifics are unclear, it appears the Republican-controlled Congress plans to curtail what “Obamacare” called 10 essential health benefits – things like maternity care, mental health services and prescription drugs that every health care plan is legally required to provide.

“The (Republican strategy) is allowing for these catastrophic plans to come back into place,” she said. “It’s kind of a big step backwards for public health.”

Supporters of a broader range of coverage options argue that individuals should have the freedom to choose the health insurance they want.